I'm very interested in this thread, but I'm only going to add one small portion. I'm the one saying that I don't know if I would have attended someone with my own "issues" once I'm a CPM. I picked a very experienced MW who was comfortable. I don't KNOW if she was at the outside of her comfort zone, but she had faith in me and gave me lots of tools to make my situation safer and safe enough to comfortably home birth (even for me).

As a new midwife, I would probably have to consult with a colleague to discuss whether I would choose to be my midwife (that's so weird) or if I would refer me to a (more experienced) midwife.

Since I've been a student for 4 whole months, I'll be quiet now and read everyone else's wise comments.

I don't give discount for coming late-to-care because I also don't charge more for more services. I feel it would be unethical for me to charge a woman more because her baby had a shoulder dystocia or because she had a 40 hour labor or because she asked more questions than my other clients. So, if I don't ethically feel I can charge more for those who take more time and skill to deal with then how could I possibly charge less to anyone else?

I agree with this. I had zero false alarms, I only called with questions a total of 5 times during my entire full term pregnancy (and only one of those calls was at night, lol) my labor was precipitous and one midwife was there for about 10 minutes of it (the other one missed it by about 10 minutes) and there were no complications. They still had to stay for a couple hours after to clean up, check the baby, etc., but still, all in all they were present for a lot less time than they are for women with 40 hour labors, who have 3 false alarms for which the midwives head to their houses, only to check them and find out they're going to be going back home. But I wouldn't even dream of thinking I shouldn't have to pay as much.

OB's don't charge less for women who show up pushing than they do for women who come in 22 hours before their baby is born. They don't charge less for women who only transfer to their care at 24 weeks, because they charge a global fee for maternity care. You just don't see that because your insurance company pays it. And heck, OB's aren't even PRESENT for 99% of a woman's labor, but if your insurance is footing the bill, they will pay your OB the SAME global fee they'll pay your midwife, even though your midwife generally spends a lot more time with you during your labor. How is that fair?

I have been considering my reply
I guess you could see if anyone would provide care under your terms without doing any prenatals-
maybe you are that quick and straight forward as far as what you want and know exactly how I as a midwife would fit into that role but in my experience it turns out more like blind dates- I know how to be polite, I know how to catch a baby and the details- and sure I could probably show up anywhere- and do that job, the way I think of doing it at the time- but will it be what you want, will it be the best care I can provide no. will there be any ease between us or will you feel like now I see your dirty corners and ratty underwear and will be judging you... and how safe will I be to provide a service to you? I mean do you live in a crack house? or with someone who is violent? have you been going to a physician for care and what misinformation has he/she passed on to you? or oh you forgot that you are perfectly fine and eat "fine" but are on metformin and your blood sugars are well controlled so that means fine- or that you have always been anemic and it is no biggie or who is this person you are bringing with you?. do you have a yeast or BV infection? how about constipation, infact what have you been using? there are no behaviors or words you would prefer I do not do or say.

perhaps your ideal is less care, but I don't see how less care fits in at all that is pretty much what a regular OB provider offers- 5 minutes, 15 minutes is an extended visit- limited contact with little continuity of care ultimately nets many more tests, several ultrasounds for dating,growth, looking for potential genetic markers, no trust relationship, labor with someone you meet that day infact it could be several persons you meet for the first time that day and will probably not see again- and tada we have a 1/3 of the population with a c-section rate...
when we say this is how we know how to provide care and to do less is to get less and it may not work the same way I have almost always regretted the last minute clients, it is the rare one I have not- things I have come across even in women who have had care- such a severe established yeast infection that caused/contributed to severe tearing but the repair also was a challenge to get to hold , constipation bad enough to cause dystocia, how about a boyfriend who is so racist that he calls your assistant names and becomes violent, or how about IV drug use, or the dad that gets drunk while mom is in labor, or how about a mom who passes out from low blood sugar several times not to mention other things like hemorrhages, transfers to the hospital, misunderstandings about a whole list of things- hum maybe the last gal who we did last minute she had not heard of me before so did not want me at the birth- had the baby within a week of transferring care did not pay the mw got pregnant again called the gal I work with wanted my phone number -- now we have worked out more flexable care for people we know well or have provided care for several babies and we already have a trust relationship and they only want short touch base appointments and they would call if there were any need or something for advice but a complete stranger no---

maybe you are that quick and straight forward as far as what you want and know exactly how I as a midwife would fit into that role but in my experience it turns out more like blind dates- I know how to be polite, I know how to catch a baby and the details- and sure I could probably show up anywhere- and do that job, the way I think of doing it at the time- but will it be what you want, will it be the best care I can provide no. ---

May I answer for myself, please?
Yes, it is the best care you can provide for me. Because it is what I am asking for.

Quote:

Originally Posted by mwherbs

will there be any ease between us or will you feel like now I see your dirty corners and ratty underwear and will be judging you ---

Honestly? I do not care. You are hired to make sure I am and my baby is all right. It is not a social outing, YK?

Quote:

Originally Posted by mwherbs

... and how safe will I be to provide a service to you? I mean do you live in a crack house? or with someone who is violent? have you been going to a physician for care and what misinformation has he/she passed on to you? or oh you forgot that you are perfectly fine and eat "fine" but are on metformin and your blood sugars are well controlled so that means fine- or that you have always been anemic and it is no biggie or who is this person you are bringing with you?. do you have a yeast or BV infection? how about constipation, infact what have you been using? there are no behaviors or words you would prefer I do not do or say.
---

1) we agreed that you'll have 1-2 prenatal, at least one will be at home. Most likely you will know about the "crack house" as well as my birth arrangements. If you have at least some experience with the drug addicted, you'll know, I am one of them within first minutes you meet me. particularly at my home.

2) when I say "my labs are fine" it means they are fine Anemic, yeast infection, etc would be considered far from being fine, would they??
If I have constipation, my health is obviously not fine either: I need to change my diet and/ or life style. We are talking about a woman who knows how to and able to take care of herself.

I am not sure what's your point when you talk about extremities: like violent/ drunk boyfriend, drug abuse and things like that. How normal it is in your practice??

As I said before, there is no need to justify your desire to make as much money as you can. I have nothing against it.
What I am against is when other people take right to decide for me what is better for me (Whether it is because of their kindness or monetary interest)
I am a big girl and happen to learn by now what I like and what works for me.

Let's say, I am asking for an apple and what to pay for it. Someone thinks the whole bag of fruits would be better. It may for some people but some may be allergic to oranges you have in your bag.
Is it individualized approach?

In the long rung, f it were that risky to do 1-2 prenatals and catch the baby, why would be midwives who are willing to do it?

Midwives/Birth attendants- The package price of the homebirth includes complete care prenataly, at birth, and postnataly. They work with families to determine best course of treatment for the individual family by getting to the know the mother/family's wants and needs. It is more difficult for them to do their job when they don't have several months prep time and time to get to know the mother.

Olstep- Wants a homebirth without becoming emotionally involved and without much prenatal care. Has found a MW who will provide this. Is okay that there are midwives who wouldn't feel comfortable with that and who would charge full price.

So, what's the issue? Olstep, you want a specific type of care and have found it. Great! Most midwives wouldn't prefer that type of care. That's okay too. Why the contention?

The point is no, you can't answer for yourself. Sorry. There really are dishonest, confused, weird, and dangerous people in the world. Can you see that? The only thing any of us have to go on when deciding if we're comfortable is our own best judgment. What happens when we don't have an opportunity to form that judgment?

What happens when after the birth, the client decides that really wasn't the best care? What defense does the midwife have when that client gets on her blog, on the local birth network, on MDC and says "my midwife was horrible"? (The answer is none, HIPAA and professional ethics prevent her from being able to respond.)

Quote:

Originally Posted by olstep

If you think that it is all right that a woman can't get a care which meets her needs (I hope you read OP), I do not think it is right.

If you think that it is all right that a midwife can't provide care in a way that meets her own needs (I did read the OP), I do not think that is right. We are people, too. Just because we're not pregnant doesn't mean we're not women with our own needs.

You argue that women should have the right to choose the midwife that's right for them. Why don't midwives have the right to choose the clients that are right for them?

There really are dishonest, confused, weird, and dangerous people in the world. Can you see that?

No, I do see that. I believe these people are quite rare. However even one person's comment is enough to blemish a reputation.
I didn't think about it. Thanks for posting.

Quote:

Originally Posted by nashvillemidwife

You argue that women should have the right to choose the midwife that's right for them. Why don't midwives have the right to choose the clients that are right for them?

It is not their right to choose that I question but the fact that money makes a client the right one. They are ready to take a woman at the end of her pregnancy, if she pays the full fee. If she doesn't, it is too risky. I am sorry but it doesn't sound right. Particularly when we talk about people who are supposedly holistic, spiritual and things like that.

It is not their right to choose that I question but the fact that money makes a client the right one. They are ready to take a woman at the end of her pregnancy, if she pays the full fee. If she doesn't, it is too risky. I am sorry but it doesn't sound right. Particularly when we talk about people who are supposedly holistic, spiritual and things like that.

Two things, from a midwife's perspective.

1. It's not that we'll take her just because she's willing to pay the full fee. We charge the full fee because we still try to get to know her and develop that level of trust. We have more visits. We have longer visits. We earn that money just as much as if we saw you for 10 visits.

2. It's called hazard pay. If you admit that we are taking an additional risk by agreeing to take a client on like that, why aren't we entitled to compensation for taking that risk?

No, I do see that. I believe these people are quite rare. However even one person's comment is enough to blemish a reputation.
I didn't think about it. Thanks for posting.

They may be rare in the general population, but we're talking about pregnant women and postpartum mothers. No offense, but tired, anxious, sleep deprived, and sometimes depressed women sometimes experience reality a little different than the rest of us. Circumstances and agreements that were okay during pregnancy are often not okay once the baby is here. Disagreements and disappointment with the midwife are quite common for clients who did not really get to know her. I can tell you this with absolute confidence; you are one woman with your experience with your midwives, or perhaps a few friends with their experiences. I am a midwife with 300 clients under my belt. Taking clients under the circumstances we are discussing imposes inherent risks.

No, I do see that. I believe these people are quite rare. However even one person's comment is enough to blemish a reputation.
I didn't think about it. Thanks for posting.

It is not their right to choose that I question but the fact that money makes a client the right one. They are ready to take a woman at the end of her pregnancy, if she pays the full fee. If she doesn't, it is too risky. I am sorry but it doesn't sound right. Particularly when we talk about people who are supposedly holistic, spiritual and things like that.

people who are holistic, spiritual and things like that also deserve to be paid in full and make a living

i live in Canada where midwifery is funded, so i will never face the issue posted by the OP. but midwifery care is a philosophy of care and inherent in that philosophy of care is a relationship built between a midwife and her client that extends through the prenatal, birth and postpartum period (the reasons for which have been mentioned by many posters all ready).

if a woman is not wanting the more intimate care of a midwife or if she does not want to pay for full services, then it would seem that she could find a physician or OB who would be more of a philosophical match to her needs.

I had DD at home at an NHS-attended HB in 2006 and i'm now at 40+1 with #2, whom we plan to have at home with an independent midwife. Things are a little different in the UK because there is a standardised training requirement and a regulatory body which ALL midwives must have and answer to, whether they are independent or NHS.

Some of the differences i noticed just between NHS and IM models (in the NHS model a team of 4-7 community midwives did my appointments under the back-up of a named obstetrician, in the hopes that one or more of those midwives would be able to attend my birth, so i wouldn't be with a total stranger, which was something i wanted to avoid, with the IM model i have one midwife who cares for me and attends me in labour, and she has a back-up who i have met who will attend me in labour too, the back-up MW is included in the fee):

1. at my booking appointment with DD, in a busy hospital, after being seen by a nurse a radiographer and a midwife and being in 4 different waiting rooms for a total of 3 hours, when measured with a machine which brings back vivid memories of all the times, when i was a teen, when i watched my mother having heart attacks, die and be resuscitated, my BP was 153/85 - i have whitecoat hypertension even when checked with a sphig, and the machine only makes it worse, and told them this. The midwife informed me that whitecoat hypertension "doesn't exist" and sphigs "are banned due to the mercury in them".

At my booking with my IM after an hour in my own home drinking tea and getting to know my midwife (who had already offered invaluable and FREE advice over email while i went through 2 miscarriages) a little better, my MW informed me that she only uses the sphig and doesn't like the machines much. Her sphig doesn't contain mercury. My BP was 122/70.

2. During my pg with DD i developed hypothyroidism. I had a large goiter, my already "high" BP went up, i had swelling in my face and hands, i had painful joints. I saw 9 midwives, 2 Obs and 3 registrars. None of them diagnosed me. I was checked for PE 6 times (i never spilled protein, my bloods were always normal), but never for anything else.

About a month ago at an appointment with my IM (which have all been in my own home and never less than 50mins - usually they are 2 hours or more, but that time she had a woman in labour to get to) she noticed i seemed twitchy and that my BP and the babe's heartrate were a little higher than normal. Within 2 days she'd helped me figure out my thyroxine was too high and i'd had my dose reduced which maintained my health, rather than curing something after the event.

3. From 39+6 with DD my BP was so high at appointments (every time they took it, with the machine, they gave me a sage warning that i'd have to go to hospital, i'd need a csection, and my baby might die IF i didn't "make it go down") that i had to go to hospital for monitoring 3x a week. I am very scared of hospital - that's why i birth at home. The obstetrician's response to this was to say "but labour wards aren't for ill people" - unfortunately that one blase statement doesn't wipe away my vivid memories of seeing my mother in various stages of illness and recovery (she had 2 terminal illnesses, a heart complaint and then cancer, and died, thankfully in a hospice, when i was 24) or the physical response i have to them when i see, hear and smell a hospital. Would i go there to save my life or my baby's? Yes. Would i go there and expect to dilate and birth normally? Um, not in a million years! It is fine if you are the sort of person who can birth without oxytocin, whose emotional state is completely detatched from their physical (though i think you'd bleed to death at the dentist if that was really true) but for most women emotions DO play an important part in how birth goes. During that time (i had DD at 41+4) i had 5 VE's, 4 membrane sweeps, one of which was very painful, a GTT i didn't consent to (in fact i declined it right before they did it anyway!) and lots and lots of blood tests for PE. Not to mention having my BP taken, with the dreaded machine, at least 4 times in every visit, sometimes as much as 7 times. I was rigid with fear each time. It was awful enough that i considered stopping at one child so i wouldn't have to go through it again.

At this stage with my IM i've had no VE's, my BP is a little higher than at booking, but still well within normal, she has carefully monitored my mood and general demeanour, which with hypothyroidism is actually a very good indicator of wellbeing. She wrote in my notes we will discuss a sweep if i make it to 41 weeks but has openly said she doesn't do them usually (though will if asked and it seems safe).

4. During DD's birth the midwife arrived to find me moaning and groaning through contractions and feeling like i needed to push. A VE found me not in what they call active labour (i was 50% effaced and 2-3cm dilated) and the midwife said i should "think about pain relief options" because "what we can do at home is very limited". She left. DD rotated and descended in one contraction. I spent 2 hours gritting my teeth and trying not to push. After 2 hours she returned with her back-up, gave me the gas and air and told me to "try to calm down". I continued for an hour to fight desperately not to push, then DD's head crowned. The midwife was thoroughly shocked, we'd never met before, she assumed i was a noisy wimp, rather than a woman in transition whose cervix hadn't read the textbook.

Obviously i haven't had this baby yet, i don't know what my birth will hold for us all. But i do know with complete confidence that if i am noisy my midwife will know it's because i'm feeling something - she KNOWS i'm not a complainer, she knows HOW to respond to me, because she knows ME. Under my skin? Well, she's not a burrowing parasite! I don't see how she could do her job properly without knowing me well. If i wanted an impersonal medical back-up i'd UC and call an ambulance when i was pushing. That is not nearly as safe, even for low-risk women, as homebirth with an experienced midwife with whom they have a pre-existing relationship, but if i wanted it that's how i'd get it.

I think expecting a midwife to be able to show up and "catch" the baby without any personal prior knowledge is very unrealistic. Sorry, but there it is. If you die, it's on her shoulders, if your baby dies, likewise. In the UK no-one will insure IM's so if we decided to sue her it would be her actual family that was destroyed. Every time an IM takes on a client she takes on substantial personal risk, both in terms of her own self (pretty sure no-one wants to be responsible for a death) and financially. There are IM's here who have been sued for injuring babies at a dystocia birth where the baby could have actually died even in hospital - because there was no Ob there to say "well we did all we could" she was under substantial suspicion. If the same baby had had the same outcome in hospital there would have been a lot of back-slapping and "well done for saving the baby" for the Ob and a "sorry, these things happen" for the family. For every midwife that takes on a woman the risk of that pregnancy and birth is being shared. And she deserves to be remunerated for that doesn't she? You get the baby for taking your risk - what does she get? Do we pay the police only if the other guy ACTUALLY has a gun? Or the paramedic only if the old guy really WAS having a heart attack after all? No, we pay them for the risks they take and the responsibilities they carry for protecting and caring for the rest of us.

To be honest if i wanted someone who could show up, catch my baby in such a way that was a) what i wanted and b) perfectly safe, i wouldn't be looking for a midwife, i'd need a psychic.

In some sense, I think it depends on whether you believe you are paying for your care provider's time or for their skills and experience. Yes, if you transfer in late, you will use up less of their time for prenatals. But you won't require one iota less of their years of experience, education, and techincal skills. As has already been pointed out, birth doesn't really work on a pay-by-the-hour basis. A 40 hour birth costs just the same as a 2 hour birth, so I don't see any problem with care consisting of 4 hours of prenatals costing the same as that with 16 hours of prenatals. Why is there a problem with one but not the other?

Given the conditions most homebirth midwives work under and the amount of money that they recieve for extremely demanding hours, I think it's patently ridiculous to believe that they're greedy and money-focused.

to answer no I don't have alot of the clients like the ones I have describe but any like that are too many. What it was is a list of experiences I have had with last minute clients who I probably didn't do more than 1-2 visits .BTW asking what a client is using- beyond illicit drugs are Rx meds, over the counter meds , herbs, homeopathics and EO's ...
I have been at this a long time about 25 years now- good and normal people can live in bad neighborhoods- the projects in north Portland when I lived in Vancouver I had some friends who lived there and they were fine , but we also had some would-be clients who had needles on the street and even in the back yard- quick judgment- not going to attend these people's birth if I have only 1-2 visits.... no matter what you pay me- so yes that is what I have learned people who want to avoid care may have something going on, something that is unbalanced, unhealthy or illegal - they may not, but in my experience most often they do, so I want some more appointments and more time and I tell my family I am going to be busier, s, miss the last episode of ... Lost ... and I eat more take out and I get more headaches and I spend more time processing info with other providers and stay up late reading over old records and researching any thing that might be unusual....
Nashvillemidwife -yes it could be hazard pay-
The thing is that people in general have a centering sense of well being no matter what their baseline lifestyle or health is , do we actually have the same values of knowing that you are a responsible adult that actually does have a good/practical sense of health and well being or do you have many health issues that you address or ignore but basically consider yourself to be fine- in one or 2 visits you are asking me to absolutely trust that without knowing you or understanding that about you-
things like long standing yeast infections, don't even itch and in pregnancy women can have a range of discharge that could seem normal- BTW I have seen this in more than one client who was seeing a doc for regular visits- trusting that everything is being taken care of...

and for the OP- if she lived near me she would pay me what she could afford/sliding fee- because for me I have to see someone and get to know them, too many details involved to just let hang and not know.

we don't have to become friends, and it isn't a social gathering but we are social creatures and it is like critters I am either part of the heard or part of the furniture but if you have a sense that I am too much "other" then things don't flow well - I need to feel safe and you need to feel safe, works out better, and I do not expect to be lorded over and treated as a servant either and there are a few people I have met who do have that attitude like ok here is the money now do what you are suppose to do! oops sorry NO I am assisting you, YOU take care of yourself and the baby and I will do my best to help YOU, and advise you - I started out learning from moms who are more like UC moms are today they all expect to take care of themselves and they knew exactly why they had me there and what they wanted from me- and from them I learned how to do this and the many clients after ... you know even Odent who would basically throw out most of the clinical stuff, would keep the gatherings, singalongs or potlucks...
----

One of midwives with 30 year experience said that 99% of births she attended would've gone as well as if she hadn't been present there.
Something to think of...

Maybe this is true because of whatever difficulties the births presented (or didn't) but I don't agree. I think that number should be much lower. I great births with my midwives, and maybe they would say that I was part of that 99% (at least for one of the births)--but I don't agree. I think it went so well BECAUSE I had the peace of mind that came with having a wonderful midwife present. If she hadn't been there, my dh would have been very nervous, I would have been irritated because of that. I don't think that would have made for as nice of a birth.

We asked our HB midwife just to basically be there in case of an emergency and to catch the baby.
It was still the full fee.
We understood that it was her experience and presence that we were paying for. We looked at it like insurance.
Oh, I forgot to add that I started my care with her around 30 weeks.

Given the conditions most homebirth midwives work under and the amount of money that they recieve for extremely demanding hours, I think it's patently ridiculous to believe that they're greedy and money-focused.

And I agree with this point, especially since I read last week that the average OBGYN salary is $400K!
If a midwife just wanted to make big bucks, she would be an OBGYN LOL

And I agree with this point, especially since I read last week that the average OBGYN salary is $400K!
If a midwife just wanted to make big bucks, she would be an OBGYN LOL

At the rate my midwife charges, and the number she said she takes on per month, that would put her at less than 1/4 of that... and that is BEFORE you take out all of the expenses that that helps her cover, such as gas, equipment/upkeep, any payments she has to make on her office (taxes or whatever, I dont know if she owns it or what), etc.

When I figure how much all of that costs... I cant imagine she brings much more home than DF does at the end of the year.

Artist, photographer, stay-at-home-mom and Marine wife. Mom to 4; a boy and three little girls.

I states where midwives are licensed(well, and anywhere, really, I'm just thinking of something glaring here), they have serious liability issues, JUST like OBs. If they need to do things to "cover their ass" so to speak, thats their right!! I want them to be upfront with me from the get go as to what some of those things may be, but otherwise, I don't blame them for it one bit.

I agree, if you want to save money and just have someone "catch the babe", call 911.

I skipped a page or two of replies, so sorry if I missed anything .

S, mama to boy M(6/07) and baby girl R(7/10). We do all the good natural family living stuff!

I guess I should also say that it never hurts to ask what a midwife might be able to work out with you financially, just like any other care provider, but you shouldn't hold it over her or her global profession if she isn't able to do just what you want for exactly the price you want.

S, mama to boy M(6/07) and baby girl R(7/10). We do all the good natural family living stuff!

I just wanted to chime in that I, too, felt like I was buying insurance for my midwife's skills and expertise. I was a very low-maintenance client, very rarely called my midwife, had my daughter on her due date - the MWs were at my house for less than 12 hours.

I knew when I signed on with my midwife that I would be paying the full fee for her services, regardless of what actually happened. I knew her services to me could range anywhere between doula in the event of an unforseen hospital birth to catching a vertex baby to delivering a baby that turned breech in labor to a million other scenarios.

I expected my midwife to commit to me for any and all circumstances, so I did not find it unreasonable or unfair to pay her for that commitment. If every birth went like mine, my midwife could schedule a birth seven days a week. They don't, so asking her to have time set aside to provide me with her skills and expertise was worth her price.

I paid less for my midwife's complete package than I would have for a birth alone at the hospital, so I really can't imagine complaining about the cost. I also find the use of words like "forced" offputting when it comes to describing a midwife-client relationship, since nobody forced you to use a midwife in the first place. If you don't like the terms of a midwife's services, don't contract with her. It seems really simple.

They may be rare in the general population, but we're talking about pregnant women and postpartum mothers. No offense, but tired, anxious, sleep deprived, and sometimes depressed women sometimes experience reality a little different than the rest of us. Circumstances and agreements that were okay during pregnancy are often not okay once the baby is here. Disagreements and disappointment with the midwife are quite common for clients who did not really get to know her. I can tell you this with absolute confidence; you are one woman with your experience with your midwives, or perhaps a few friends with their experiences. I am a midwife with 300 clients under my belt. Taking clients under the circumstances we are discussing imposes inherent risks.

Your explanation is clear and makes sense even though I do not agree with how you pictured pregancy/ postpartum emotional state. But I take your word for that because of your experience.

One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?

if a woman is not wanting the more intimate care of a midwife or if she does not want to pay for full services, then it would seem that she could find a physician or OB who would be more of a philosophical match to her needs.

I. If i wanted an impersonal medical back-up i'd UC and call an ambulance when i was pushing. That is not nearly as safe, even for low-risk women, as homebirth with an experienced midwife with whom they have a pre-existing relationship, but if i wanted it that's how i'd get it.

Why would you do something you consider unsafe: UC or an ambulance (unless you consider childbirth an emergency)?
Even for the most independent woman safety would be higher on your her list than impersonal care, don't you think?

One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?

THere are risks for an OB who is oncall and has women walk through the door with no history, no prenatal care, etc. However, as midwives and depending on the states we are practicing in, we run the risk of jail or prison time if things go poorly. Not just a lawsuit, but time behind bars. OBs do not have that same kind of risk.

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

so in our state people have a "right to sue"part of our constitution in any case- we now have recent- legislation to limit liability for delivering docs for non-established patients, additionally you have docs who refuse to see pregnant patients if they have not established care by 12 weeks- they will end up seeing them in the hospital for delivery but then their liability will be limited- the other thing is that docs do respond to this danger by pro-actively and inapproprately doing the most that they can do - thus elevating the c-section rate beyond what is safe or healthy for moms or babies

Why would you do something you consider unsafe: UC or an ambulance (unless you consider childbirth an emergency)?
Even for the most independent woman safety would be higher on your her list than impersonal care, don't you think?

Perhaps, but if you ask a midwife to care for you properly in a way which is safe, she is going to get to know you. She is going to NEED to get to know you. I don't want impersonal care; it isn't safe. Asking the midwife to show up, catch the baby and go away again, and charge a fee reflecting those few hours of work, would be dangerous.

Incidentally i had my baby, after a long stop start labour we managed to get the midwife there about 45mins before the birth. Contractions became regular about 55mins before i was pushing, i pushed for 6 mins. Baby had a true knot, but apgars were 10, 10 and 10. My midwife didn't *even* catch my baby (we had already discussed that i wanted to and in the moment i did it without thinking), i did, but having her there, and knowing her, and her knowing me, meant that she was able to support me through the labour (we called her several times for input) i was able to trust my body and the process and my baby was able to get herself out safely. I doubt a hospital would have been able to tell there was a knot from the pattern (my MW suspected but didn't say lest she frighten us) and i'm sure augmentation would have caused major problems, possibly death. I am very grateful for the months of groundwork my MW put in with us, and i believe it made what could have been life and death difference for us and our specific baby.

Each to their own, i can only say that for us to ask our midwife to only "do the birth" wouldn't have been safe, and i would not blame any midwife for declining to take on a client with that request.

I do not understand why you need to give up on your personal life, family events, etc for 6 weeks to provide your service on the one only day when actual birth will happen.
I am not a MW and I do not know this job.

Well, first of all, when you're on-call you can't go further away than an hour from your client (or sometimes less depending on her history). This means for me, no trips to Denver, no trips to the mountains, etc. Speaking of the mountains, you can only go places where you have adequate cell-phone reception. If you do venture an hour away or go on any group outing, you need to take two cars and arrange for back-up transportation and childcare for your kids in case you have to leave mid-way. You can't ever have more than one small glass of wine, and need to get to bed at a reasonable time. You don't sleep as well, because you're on-call and expecting the phone to ring at any time. You don't volunteer to do anything like volunteer for your kids' events during this time, because you may not be there. When your client is in rumbly, but not even early, labor you decline invitations to movies and parties, and holiday gatherings because she is so close, and then two days later you still are waiting. And your kids wonder why you weren't at Easter Dinner when there was no baby.

Being on call 24/7 is brutal. No one, NO ONE, but hb mws in the US do it this way. But we know, more than anyone, the importance of continuity of care, and that is why we do it. And that is also why care throughout the pregnancy is ideal. It's part of the Midwives Model of Care, and if you believe that a mw does nothing more than show up and catch the baby, then you are discounting the very model that your intended practitioners believe in with their hearts and souls.

If a client has had prior prenatal care, I will discount a portion of each prenatal visit. If she comes late to care with no prenatal care, there is no discount.

I have not read all the responses, but my personal feeling is that a discount should be offered for each prenatal that has been done with another provider. If the midwife feels that she'll spend extra time "catching up" on care or that extra prenatals will be done to get to know the client, then that could be explained. I am 19 weeks pregnant and have had two prenatals with a homebirth midwife. I will not be seeing her again for reasons that I won't go into here. If I hire another homebirth midwife, it doesn't seem right to me to have to pay the full fee + the two prenatals I've already had to pay for. There's no issue of "catching" up...it would take 5 minutes to read the records from my previous visits, and no need for extra prenatals either. I understand that midwives don't charge a great deal (relatively speaking), but at the same time anyone I hire from here on out will have spent less time on me than on someone who hires them during the first trimester, and I feel that the fee should reflect that. If we had insurance I might not feel so strongly, but when the cost is already an issue, having to pay a couple of hundred extra IS a big deal.

Also, for me there's a possibility of hiring a midwife who won't be in the area until I'm roughly 30-32 weeks pregnant. Now I'd prefer to have some prenatal care in the meantime, but if we hire her and she won't discount for prenatal visits done with someone else, then I can't afford to pay for other prenatals.

And I would say that we hire (IF we hire this time, DH doesn't see the point of paying someone to "do nothing") a homebirth midwife as insurance at this point. I've had two completely uncomplicated pregnancies and homebirths. Birth #1 midwife was there 20 min. before baby was born, less than 3 hours total. Birth #2 midwife was there 60-90 min. (can't remember) before baby was born, about 3 hours total. They really didn't do anything besides one heartrate check per birth and some after care. But I am perfectly fine paying for that. I want someone there in case something does go wrong. I like doing prenatals with a midwife I trust. I like being able to process the birth afterwards with a midwife and seeing them for well-baby visits. I wish it were cheaper because it's going to be a stretch to come up with the money (assuming I can convince DH to hire someone) but it's worth it.